Navigating through the Affordable Care Act

Answering the most common questions about Obamacare

Published: Thursday, Dec. 19, 2013 5:30 a.m. CDT

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(Jessica Bourque – jbourque@shawmedia.com)

Health Care Marketplace Navigator Michelle Kruse presented information Wednesday about the new healthcare legislation to local business owners and professionals at the Grundy County Chamber of Commerce Luncheon in Morris.

MORRIS – Open enrollment in the new federal health insurance marketplace began more than two months ago, but many still have lingering questions regarding the Affordable Health Care law and how it will affect them.

Local insurance agents, business owners and others gathered Wednesday at the Grundy County Chamber of Commerce Luncheon to have some of their questions answered by Health Care Marketplace Navigator, Michelle Kruse of Service Inc.

“As businesses we need to know what options are available for our employees,” Executive Director of the Chamber of Commerce Caroline Portlock said.

Kruse is one of three navigators in Grundy County helping people find health coverage options through the marketplace.

Currently, Kruse, and her co-workers, are in Morris at least two days a week holding appointments at the Grundy County Health Department and Morris Hospital, and will soon take appointments in other areas of the county.

Appointments with the navigators are free and typically last 60 to 90 minutes, Kruse said.

“It depends on the person. Some people we can have in, out and registered in one day,” Kruse said. “Others with more questions may need two appointments.”

During her presentation to the more than 30 local professionals at Wednesday’s luncheon, Kruse answered some of the most common questions about the new legislation.

Why get covered?

“Nobody plans to get in an accident. Nobody plans to get sick,” Kruse said. “The American Health Care Act is trying to create a culture of coverage. We want everybody to have some baseline of coverage.”

Choosing to have insurance also means avoiding pricey penalties. Those who opt for no insurance coverage in 2014 will be charged fees when they pay their taxes. Fees could be 1 percent of the person’s annual household income or $95 a person, depending on which amount is higher.

“Nobody will be taken to jail for not being covered,” Kruse said.

Some people who face extreme economic hardship, like the homeless, will be exempt from these fees. Those who switch jobs and are temporarily uninsured also will be exempt, provided they are uninsured for less than three consecutive months.

Kruse said penalties are scheduled to increase every year; in 2015, the fees will be 2 percent of income and $325 a person. The fee increases are meant to drive those without coverage into buying an insurance plan.

“With these fees, you reach a point where you have to decide how much you are willing to pay to get nothing in return,” Kruse said.

Who can enroll?

No one will be denied insurance coverage based on pre-existing health conditions, including but not limited to diabetes, asthma and cancer. The only information required to enroll is age, geographic location and smoking habits.

Those who were on Medicare and Medicaid will stay with those programs. Kruse said the new legislation will expand Medicaid coverage to a broader age range so that 700,000 more Illinois residents will qualify.

Kruse said the Medicare program will stay the same.

What is included in the new plans and how much will they cost?

Plans can vary widely based on income, location, age and a host of other factors unique to each person, Kruse said.

Currently, seven insurance companies make up the entire marketplace with Blue Cross Blue Shield being the premier provider for those living in Illinois.

Across the board, every insurance plan in the marketplace must cover, in some capacity, a minimum of 10 services: outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorders, prescriptions, pediatrics, laboratory services, rehabilitation and preventative and wellness services.

Kruse said costs vary from person to person.

“We are seeing some premiums going exorbitantly high,” Kruse said.

Conversely, Kruse said many of her clients have seen their monthly premium decrease by hundreds of dollars. Kruse said because costs and coverage are so variable, it is important to shop for a plan that fits a person’s specific needs including their preference of healthcare provider.

What subsidies are available and who is eligible?

Kruse said most Illinois residents will receive help paying for their plan through tax credits if they aren’t already eligible for Medicaid or Medicare.

Those with an income that falls below 400 percent of the Federal Poverty Level are potentially eligible for tax credits, Medicaid or cost sharing subsidies.

The maximum qualifying income for a household of one would be $45,960, $62,040 for a household of two, $78,120 for a household of three, $94,200 for a household of four and $110,280 for a household of five.

Those who fall below 400 percent of the poverty level are not guaranteed a subsidy, but they are eligible.

Kruse said those looking into plans should set up an appointment with a navigator to ensure they are receiving all of the subsidies they are eligible for.

How to enroll

Applications can be filled out online, over the phone or mailed in, although Kruse strongly advised against sending a paper application.

“They are saying it will take 45 days just to process a paper application,” Kruse said. “You do not want to take that route. It will take too long.”

Despite problems when it first launched, Kruse said the website, Healthcare.gov, is now fully functional.

Illinois residents are encouraged to visit GetCoveredIllinois.gov instead of the national website to see if they qualify for Medicaid or Medicare.

Kruse said those who set up their free appointment with a navigator could be signed up for a plan by the end of their visit.

“Navigators are here to help you navigate the system to find the right health care plan for you. I cannot tell you which plan to pick,” Kruse said. “I do not get a bonus based on which plans you pick – I am paid through grant.”